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information about any anxieties of the patient expressed before surgery, such as a fear of not waking after anaesthesia or fear about coping with pain

specific instructions from the anaesthetist for postoperative care.

To ensure continuity and effective communication of care for the patient. To ensure that the recovery nurse has all the information required to assess the patient’s recovery needs. E

The actual procedure performed may be different from the proposed procedure. E

To highlight specific potential postoperative complications to be assessed and monitored. E

To maintain the patient’s immediate postoperative safety with cardiovascular system and airway. E

To ensure care and management of these drains are continued and the positioning of the patient is assessed to prevent any occlusion of drains or infusions. E

To ensure that appropriate action can be taken as the patient regains consciousness and to enable assessment of the efficacy of nursing interventions used. E

To facilitate effective communication of the patient’s care and treatment. E

Postprocedure

2 All information is to be recorded in the perioperative nursing care plan.

Procedure guideline 14.6 Patients in PACU

The following recommended actions are not necessarily listed in order of priority. Many will be carried out simultaneously and much will depend on the patient’s condition, surgery and level of consciousness. All actions must be accompanied by commentary and explanation regardless of the patient’s apparent responsiveness, as the sense of hearing returns before the patient’s ability to respond (Levinson 1965, Starritt 1999).

Equipment

Self-inflating resuscitator bag, for example Ambu-bag and/or Mapleson C circuit with facemask

Full intubation equipment: laryngoscopes with spare bulbs and batteries, range of endotracheal tubes, bougies and Magill forceps, syringe and catheter mount

Anaesthetic machine and ventilator

Wright respirometer

Cricothyroid puncture set

Range of tracheostomy tubes and tracheal dilator

Central venous cannulas and manometer

Emergency drug box/trolley: contents in accordance with hospital policy

Defibrillator

Procedure

Action Rationale

1 Assess the patency of the airway by feeling for movement of expired air. To determine the presence of any respiratory depression or neuromuscular blockade. Observe chest and abdominal movement, respiratory rate, depth and pattern (Drummond 1991, C).

2 Listen for inspiration and expiration. Apply suction if indicated. Observe any use of accessory muscles of respiration and check for tracheal tug. To ensure airway is clear and laryngeal spasm is not present. E

3 If indicated, support the chin with the neck extended. In the unconscious patient the tongue is liable to fall back and obstruct the airway, and protective reflexes are absent. E

4 Suction of the upper airway is indicated if gurgling sounds are present on respiration and if blood secretions or vomitus are evident or suspected, and the patient is unable to swallow or cough either at all or adequately. Suction must be applied with care to avoid damage to mucosal surfaces and further irritation or initiation of a gag reflex or laryngeal spasm. Foreign matter can obstruct the airway or cause laryngeal spasm in light planes of anaesthesia. It can also be inhaled when protective laryngeal reflexes are absent (Dhara 1997, C).

5 Endotracheal suction is performed following the same procedure as that for suction of tracheostomy tubes (see Chapter 10). To maintain the patency of the tube and remove secretions (Dhara 1997, C).

6 Apply a facemask and administer oxygen at the rate prescribed by the anaesthetist. If an endotracheal tube or laryngeal mask is in position, check whether the cuff or mask is inflated and administer oxygen by means of a T-piece system. To maintain adequate oxygenation. Oxygen should be administered to all patients in the recovery room (Nimmo et al. 1994, C).

7 Observe skin colour and temperature. Check the colour of lips and conjunctiva,